The healing power of nature

At the annual meeting of the Provincial Medical and Surgical Association in August 1844, a doctor from Newport Pagnell in Buckinghamshire, Edward Daniell, presented this unusual case. He prefaced his account with the observation that it would ‘perhaps be interesting more from its novelty than for its value in a surgical point of view’. He wasn’t just being modest: as it turns out, his involvement in proceedings was virtually nil.

John Smith, a fisherman, aged about 25 years, went out on a Sunday morning, in the winter of 1837, with two companions. One of these persons possessed a gun, which was so constructed that it could be taken to pieces and stowed in the pocket. I am not prepared to say whether these gentlemen designed a trespass on the game-laws, or whether their predatory excursions had only reference to those minor bipeds, which the legislature have considered too insignificant for their especial protection.

Humans apart, the English countryside is not exactly known for its ‘minor bipeds’, so I’m not sure what Dr Daniell is getting at here.

I opine, however, that any wild animal capable of yielding a Sunday’s dinner, would have been in great jeopardy had it been luckless enough to cross their path at that time.

Only professional etiquette prevents Dr Daniell from calling his patient what he surely was – a poacher.

Certain it is they themselves felt that their pursuit was lawless, for they hastily took their weapon to pieces, on observing the owner of the fields approaching them. In re-adjusting it a second time the stock was not in perfect apposition, and the wiseacre…

OED: ‘A person with an affectation of wisdom or knowledge, regarded with scorn or irritation by others; a know-all.’

…whose business it was to render the weapon fireworthy, observing this defect, sought to remedy it by striking the butt end sharply upon the ground. The result may be anticipated, for the gun went off, lodging its contents in the body of John Smith, who stood about three yards from its muzzle.

No doubt many landowners of the time, confronted with a seriously injured poacher, would have been tempted to finish the job; thankfully this time nobler sentiments prevailed.

I was sent for immediately, and arrived just as the poor fellow was brought home. The contents of the gun had entered about half an inch below the navel, on the right side, and had passed out about two inches above the hip, and three from the vertebral column; the distance from wound to wound was about six inches.

Dr Daniell was not at first sure whether the shot had passed straight through the body; it was possible, he thought, that it had been deflected by the abdominal muscles and thus avoided the major organs. But on reflection he ruled out this idea as implausible.

Under the circumstances, I thought it right to give a very unfavourable prognosis, and the family of the poor man were prepared for a fatal issue. The ignited wadding or cartridge passed through the wound unextinguished, and set fire to the shirt, opposite the posterior opening.

Imagine that: he was shot in the stomach, but the shirt covering his back caught fire.

The surgeons looked upon the case as hopeless; so did I. They merely defended the wound; I did no more. There was neither probing nor poking, no endeavours to remove extraneous substances. Nature was left to her own operations, and nature…did her business, far better than we, her assistants, could.

Certainly not the way such a wound would be approached today; but in the 1840s, when surgery was basic and understanding of infection non-existent, probably quite sensible.

The wounds progressed properly, portions of garment, and other extraneous matter, passed out at the posterior opening, and about 40 shot passed with them. There still remain under the integuments perhaps 15 or 20 of the shot, but he suffers no inconvenience from them, and is scarcely aware of their existence. The man continues in excellent health.

Dr Daniell concludes with a philosophical observation:

There is one practical inference which I think may be drawn from this case, and that is, in deep and dangerous injuries, where vital parts may be involved in the mischief, the less we interfere with the processes of nature the better, and I am convinced that much evil is often inflicted by our readiness to anticipate the beautiful workings of the vis medicatrix naturae.

‘Vis medicatrix naturae’ is usually translated as ‘the healing power of nature’ – a phrase attributed to Hippocrates, and one which underlies much of the great Greek physician’s doctrine. The idea that the physician (or surgeon) should place their faith in the power of the human body to overcome disease and injury, only intervening when absolutely necessary, remained a central tenet of medical thought for centuries. Dr Daniell clearly thought that some of his colleagues were too ready to perform a heroic operation when careful watching and waiting was the better option. He may have been right.